Objective To investigate the application value of CT perfusion imaging (CTPI) combined with CT angiography (CTA) for determination and diagnosis of transient ischemic attack (TIA).Methods Totally 50 TIA patients from April 2014 to April 2016 in the neurology department of some hospital underwent examinations by CT scan,CTPI and CTA in time,and the values of cerebral blood volume (CBV),cerebral blood flow (CBF),mean transit time (MTT) and time to peak (TTP) were calculated at the uninjured and injured sides of the areas of interest.The relationship between cerebral blood perfusion and cerebral angiostenosis of the TIA patient was analyzed.Results The 50 patients had the values of CBF and CBV at the injured sides lower while the ones of MTI and TTP higher than those at the uninjured sides (P＜0.05).The numbers of the abnormal cerebral blood perfusion patients found by CT scan,CTPI and CTA were 28 (56.00％),45 (90.00％) and 38 (76.00％) respectively,who were confirmed clinically simultaneously.There were significant differences between the TIA positive result rates by CT scan,CTPI and CTA (P＜0.05).Conclusion Carotid artery hypoperfusion is one of the pathogeneses of TIA,and positive rate by CTPI is closely related to the conditions of TIA.CTPI combined with CTA contributes to the diagnosis of TIA,and can be used for its individualized treatment.

Under the new situation of rapidly expanded medical education scale and its great development,combined with the characteristics and position of higher medical education, and keeping the quality of teaching in this school lifeline,we explore the specific measures and methods to improve the quality of medical education, from the quality monitoring system of classroom teaching,clinical teaching and teaching management.

Adenocarcinoma ; diagnosis ; therapy ; Guidelines as Topic ; Humans ; Thyroid Neoplasms ; diagnosis ; therapy

Objective To evaluate the role of contrast-enhanced ultrasound (CEUS) for preoperative detection of colorectal liver metastases.Methods 42 consecutive patients with colorectal liver metastases confirmed by histopathology after surgery were recruited in the study.They all had undergone preoperative CEUS examination with contrast agent SonoVue.The number,location and size of the hepatic lesions found by CEUS were correlated with postoperatively histopathologic results on a lesion-by-lesion basis.Results 96 liver metastases in 42 patients with colorectal cancer had been resected and confirmed by histophathology.The size of the metastatic lesions ranged from 0.3～8.5 cm [average (2.6 ± 1.8)cm].From one to eight metastatic lesions were detected in one patient.21 (21.9％) metastatic lesions were equal to or less than 1.0 cm.86 of 96 metastatic lesions were correctly depicted by CEUS,with a sensitivity of 89.6％.And the sensitivity for metastatic lesions equal to or less than 1.0 cm was 71.4％ (15 of 21 tumors) by CEUS.35 metastatic lesions were found between the portal venous phase and late phase by CEUS and 19 (54.3％) metastatic lesions among them could not be detected at conventional ultrasound.The curative resection was performed in 37 (88.1％) of 42 patients.With 3 - 39 months follow-up,the intrahepatic recurrence rate within two years was 32.4％ (12 of 37 patients) and the one-year survival rate was 90.0％.Conclusions CEUS is highly sensitive for detecting liver metastases resulted from colorectal cancer,especially for small metastatic lesions.CEUS is helpful to choose reasonable therapeutic strategies and can be regarded as one of the most importantly and noninvasively preoperative imaging modalities.

Objective To investigate the radiation dose differences of DTS,DR and CT in diagnostic imaging of the skeletal system and analyze the sensitivity and specificity of each modality in skeletal disease diagnosis.Methods 100 relevant patients with skeletal diseases were randomly selected,who were performed with DR,DTS and CT from Feb 2010 to Mar 2012.They were divided into three groups,respectively as the DR group,the DTS group and the CT group.The complete information including DR,DTS,CT data and the final clinical diagnosis were collected and the statistical analysis after comparing radiation dose of DR,DTS and CT examination.Two experienced experts evaluated the image of three examinations and made judgments.ROC curves of reader A and B were made by using the final clinical diagnosis as gold standard.Results The average absorbed dose and effective dose of DR,DTS,CT group were [(1.9±1.8)mGy,(0.03±0.03) mSv)],[(3.5±1.5)mGy,(0.05±0.02) mSv)],[(397.7 ± 106.0) mGy· cm、(5.60 ± 1.50) mSy] respectively.The difference among the three groups was analyzed by one-way ANOVA test(F =1377,P ＜ 0.05) and had statistically significant(P ＜ 0.05).ROC curve was drawn through analyzing lesion detection credibility of three groups.The Az values of reader A and B was (0.870 ± 0.035,0.966 ± 0.018,0.974 ± 0.015) and (0.852 ± 0.038,0.951 ± 0.021,0.959 ±0.019)respectively.Do the Z-test to these examinations' area under ROC curve of lesion detection credibility.Between DR and DTS or DR and CT,there was statistically significant(P ＜ 0.05).While for CT and DTS,there was not statistically significant.The two readers' sensitivity and specificity in diagnosing skeletal lesion with DR,DTS and CT were investigated using the x2 test:CT and DTS were no statistical significance,CT and DR were statistically significant (x2 =4.833,P ＜ 0.05).Conclusions Radiation dose of DTS only accounts for about 1％ of CT examination.While its sensitivity and specificity can meet the requirements for clinical diagnosis as CT.If the DR diagnosis is unclear or suspected,DTS should be the first recommended modality used for skeletal diagnosis with lower radiation dose.

Objective To investigate the clinical efficacy of three-dimensional (3D) and two-dimensional (2D) laparoscopic surgeries in the treatment of Todani type Ⅰ choledochal cyst.Methods The retrospective cohort study was conducted.The clinical data of 59 patients with Todani type Ⅰ choledochal cyst who were admitted to the People's Hospital of Hunan Province between January 2013 and January 2016 were collected.Thirty patients undergoing 2D laparoscopic surgery between January 2013 and June 2014 were allocated into the 2D group and 29 patients undergoing 3D laparoscopic surgery between July 2014 and January 2016 were allocated into the 3D group.There were the same Trocar placement and surgical procedure in the 2 groups,and surgical procedure completely followed the treatment principle of Todani type Ⅰ choledochal cyst.Observation indicators included (Ⅰ) surgical situations:conversion to open surgery,operation time,volume of intraoperative blood loss,(2) postoperative situations:postoperative complications,(3) follow-up.Patients were followed up by outpatient examination or telephone interview to detect postoperative recovery up to April 30,2016.Measurement data with skewed distribution were presented as M (range) and analyzed using the Mann-Whitney U test.Count data were compared by Fisher exact probability.Results (1) Surgical situations:patients in the 2 groups underwent laparoscopic choledochal cystectomy + Roux-en-Y hepaticojejunostomy.Two patients in the 2D group received conversion to open surgery and patients in the 3D group received the successful surgery without conversion to open surgery.Rate of conversion to open surgery in the 2D and 3D groups were 6.7％ (2/30) and 0,respectively,with no statistically significant difference (P ＞ 0.05).Operation time in the 2D and 3D groups were 285 minutes (range,240-390 minutes) and 190 minutes (range,140-215 minutes),with a statistically significant difference (U =40.0,P ＜ 0.05).Volume of intraoperative blood loss in the 2D and 3D groups were 50 mL (range,10-300mL) and 45 mL (range,20-250 mL),with no statistically significant difference (U =1 018.5,P ＞ 0.05).(2)Postoperative situations:patients in the 2 groups had good recovery,without occurrence of severe complications in Clavien-Dindo≥ Ⅲ stage.Four and 1 patients in the 2D and 3D groups were complicated with bile leakage (in Ⅱ stage of Clavien-Dindo) and 1 and 1 were complicated with upper gastrointestinal hemorrhage (in]][stage of Clavien-Dindo),respectively,with no statistically significant difference (P ＞ 0.05).Overall incidence of complications in the 2D and 3D groups were 16.7％ (5/30) and 10.3％ (3/29),with no statistically significant difference (P ＞ 0.05).All the patients were cured by conservative treatment.(3) Follow-up:59 patients were followed up for 5-36 months,with good recovery and without occurrence of reflux cholangitis,hepatic and intestinal anastomosis stenosis and reoperation.Conclusions 3D and 2D laparoscopic surgeries are safe and effective for Todani type Ⅰ choledochal cyst.Compared with 2D laparoscopic surgery,3D laparoscopic surgery can reduce the operation time and not increase the complications,and it should be discreetly promoted based on the experiences of surgeons.

Aim To investigate the expression of GRKs in rats of synovial tissue with collagen-induced arthritis(CIA) and the effect of total glucosides of paeony.Methods SD rats were divided into six groups including normal,model,TGP(25,50,100 mg?kg-1)groups,GTW(40 mg?kg-1)group.Chicken type Ⅱ collagen was used to induce CIA in rats.The expression of GRKs was detected by Westernblot.Results The expression of GRK2,5,6 increased in model group than that in normal group.Compared with the model group,the expression of GRK2,5,6 decreased in TGP groups.Conclusion In rats of synovial tissue with CIA,the expression of GRKs was abnormal,and TGP could change the variation of GRKs which may be one of the mechanisms of TGP improvement CIA.

BACKGROUND: Neuroprotective role of hypothermia on cerebral ischemic-reperfusional impairment has been long acknowledged. Since general hypothermia is complicated and unfit for observing postoperative consciousness and neurological function, it is of important significance to explore novel methods of focal cerebral hypothermia.OBJECTIVE: To study the neuroprotective effect of lateral ventricle infusion of low-temperature fluid on ischemic neurons of middle cerebral artery (MAC) occlusion models established on New Zealand rabbits.DESIGN: A randomized case-control study based on experimental animal models.SETTING: Neurosurgical department and pathological department of a general military hospital of Chinese PLA.MATERIALS: This study was carried out at Neurosurgical Laboratory of Nanjing General Hospital, Nanjing Military Area Command of Chinese PLA. Altogether 18 healthy New Zealand male rabbits, weighing from 2. 8 to 3.2 kg, were selected 4 - 6 months after birth, and randomly divided into occlusion group, hypothermia group and control group.INTERVENTIONS: Cerebral focal ischemic-reperfusional model was established on the New Zealand rabbits through MCA occlusion for 2 hours followed by reperfusion for 24 hours.MAIN OUTCOME MEASURES: Scores for neurological function, water content in the left and right brain, pathological changes of nerve cells in the left MCA supplying region.pothermia group, significantly higher than that in occlusion group(7.58 ± 0.58 )( P ＜ 0.01 ), but no significant difference could be observed in contrast with brain was(81.64 ± 0.82)% and (79.26 ± 1.30)% in occlusion and hypothermia groups with significant difference between them( P ＜ 0.05), and it was significantly different between the left side [ (81.64 ± 0. 82 )% ] and opyknosis and deep staining could be observed in nerve ganglion cells in occlusion group under optical microscope, but no obvious pathological changes were observed in MCA supplying brain regions in hypothermia group.CONCLUSION: Permanent infusion of low-temperature fluid into the lateral ventricle plays an important neuroprotective role by attenuating cerebral ischemic-reperfusional impairment and improving post-ischemic neurological functions.

Objective To probe the feasibility of gemstone spectral CT in imaging pulmonary angiography with low dose contrast medium.Methods A prospective study with multi-slice spiral CT pulmonary angiography was performed in consecutive 48 patients suspected with pulmonary embolism.Two groups (n=24 respectively)were divided at random including Group A used Gemstone spectral CT with 35 mL of contrast medium and Group B using 64-slice CT with conventional 80~90 mL of contrast medium.The CT values of the pulmonary trunk,lobe artery,pulmonary vein and ascending aorta were measured.The contrast to noise ratio of the pulmonary artery was also calculated.In addition,the image quality of CTA was evaluated independently by two experienced ra-diologists.Results The CT values of the pulmonary trunk and the subsegmental branches,and the CNR in Group A were signifi-cantly higher than those in group B,exhibiting statistical differences (t=8.6,P <0.001;t=12.2,P <0.001;t=1 1.3,P <0.001 respectively).However,the CT value of aorta in Group A was significantly lower than that in Group B (t=-7.6,P <0.001).The evaluation results of the CTA images by two radiologists showed that the image quality in Group A was better than that in Group B (Z =-8.6,P <0.001;Z =-9.0,P <0.001 ).Conclusion The image quality of pulmonary angiography with gemstone spectral CT using low contrast medium dose can be improved compared with the conventional spiral CT.

Objective To observe the effects of blood nourishing and wind expel formulae on learning and memory capabilities of rats with tic disorders. Methods Intradialytic Parenteral Nutrition peritoneal injection was used to establish the rat model of tic disorders. The successful test subjects were categorized into 5 different groups, namely the model group, the Chinese medicine groups (low dosage, medium dosage and high dosage) and the western medicine group. The test groups were each given gastric perfusion of the related medicine, whereas the control and model groups were each given equal amounts of saline solution continuously for 8 weeks. Open field test and water maze test were carried out in the 1st, 4th and 8th weeks to evalute the learning and memory capabilities. Results In comparison with the control group, the model group showed obvious increase in movement across grid and decrease in vertical locomotion. Statistical significance was obtained showing an increase in vertical locomotion in the treatment groups compared with the model group. In the Chinese medicine groups, the medium and high dosage groups exhibited shorter escape latency and increased exploratory behavior (P<0.05) in the 4th and 8th weeks. Conclusion Among the blood nourishing and wind expel formula, the medium and high dosage showed ameliorating effects on the memory and learning capabilities of rats with tic disorders.